Remembering Nicky


In Memoriam




 

Our kitty, Nicholas, died on May 14, 2009. He was about 15 years old and had cancer.

Nicky was the sweetest kitty ever. He loved everyone – cats, dogs, people – and would always run to the door to greet any new arrivals. Whether or not he knew the person, when someone sat down in our home, Nicky was ready to jump up in that person’s lap. If the person didn’t want a cat in his or her lap, Nicky was content to go elsewhere. Nicky was always with us; we took him on vacations with us in our RV. We snuggled with him at night, and I looked forward to taking naps because Nicky would dive under the covers with me and snuggle then too.

We loved Nicky, and we know he loved us. It's been very hard for us to say goodbye.

 

Our loss of Nicky has been made all the harder because Nicky's final days were not as we intended them. If you would like to read our story on how an elderly cat with cancer should not be treated, read on . . .

 

Our Kitty Nicky's Cancer; a Primer in What Not to Do

 
When my husband and I learned about Nicky's cancer, we quickly decided that because of his age and that the cancer was extensive, we would not put him through any invasive procedure. Instead, we would let him live out his days as long as he was comfortable, and, when he was no longer comfortable, we'd have him euthanized.

That was the plan. The reality turned out quite differently. Through our own bad decisions and the non-advice (which translated into bad advice) by the veterinary surgeons, Nicky's final days were horrible. We've written to the surgeons a rather long letter to try to explain to them why we are upset at ourselves and at them for the way Nicky's life ended. With the hope that this experience might be helpful to others out there who have elderly animal companions with cancer, we are reproducing that letter here:


Dear Doctors _________,

 

It was one week ago today that my husband and I brought Nicky to you, and, based on our last conversation with you, we think you still don’t understand why we have been so distraught. We don’t know if we were unclear in explaining it or if you weren’t hearing what we were saying. Either way, we want you to understand. Hopefully, it will make a difference in the future advice you give to those in our position who come to you with animal companions.

 

My husband and I made the wrong decision in taking Nicky for a biopsy. You indicated that we would feel differently if Nicky’s outcome had been positive, and that’s just not true. We would not have felt differently. Nicky was a 15 year old cat riddled with cancer. We made a horrible mistake in bringing him to you, and poor Nicky suffered the consequences.

 

Before we explain further, we want to tell you a little bit about Nicky so that he’s not just a statistic. Nicky has been a joy in our lives. When I got him from a shelter 14 years ago, he was traumatized and wouldn’t eat, but over time, he blossomed. He loved everyone – cats, dogs, people – and would always run to the door to greet any new arrivals. Whether or not he knew the person, when someone sat down in our home, Nicky was ready to jump up in that person’s lap. If the person didn’t want a cat in his or her lap, Nicky was content to go elsewhere. Nicky was always with us; we took him on vacations with us in our RV. We snuggled with him at night, and I looked forward to taking naps because Nicky would dive under the covers with me and snuggle then too.

 

We were devastated when we learned late last month that Nicky had cancer, and all the more so that the first ultrasound revealed extensive involvement. We wanted to do what was best for Nicky, not for ourselves, but what was best for Nicky? Well, cats are not humans and, we believe, they don’t fear impending death as humans do. We believe that cats live in the moment, and that what’s best for a cat, especially an old cat, is to make those moments happy and comfortable, not try to prolong the cat’s life with invasive procedures that are intended to make their human guardians happy.

 

With that as our starting point, it was clear to us that we would not put Nicky through any invasive procedures.  Instead, we would let him peacefully live out his weeks or days, and when he was no longer comfortable, we would have him euthanized. That seemed to be the best course for him.

 

As it turned out, our vet prescribed prednisone for Nicky’s comfort, and Nicky flourished on prednisone, engaged in life and engaged with us. That would have made his final weeks or days a very happy time because he was a happy kitty. Then we started reading about cancer, particularly lymphoma, which was the likely diagnosis, and learned that chemotherapy has a very good success rate in cats with typically little or no side effects, and that it’s non-invasive. It was obvious to us that there was nothing to lose and possibly something to be gained – i.e., Nicky being a happy kitty longer – by following that course, so we took Nicky to an oncologist. Probably because of the prednisone, the aspiration didn’t give a diagnosis, so, we were told, a biopsy would be the next step.

 

That’s why we proceeded. We saw a biopsy as merely the “next step” in our plan for non-invasive care. We didn’t think beyond that. We didn’t think at all.

 

In fact, this is the point at which we should have stopped treatment and let Nicky live out his days in peace. Irrespective of the outcome, the biopsy route was a horrible decision, and, if we had realized what we were doing, we would not have chosen that course. We take the blame in this. We asked questions of both of you when we brought Nicky in, but on some key points, we made assumptions instead of asking questions – such as assuming a biopsy was not a big deal but was just the obvious “next step” in the treatment plan.

 

But you also should have questioned us. You should have done what my vet 20 years ago did when I brought in my dog who had a lump on his leg and the vet phoned me from the surgery saying that it was cancer spread throughout his body and was inoperable. I said I wanted to be with my dog when he died, and the vet asked, “Do you really want me to sew your dog back up and wait until he’s conscious so you can be with him when he’s euthanized?”  His framing the question that way made it clear to me: Obviously, I didn’t want to do that to my dog.

 

You should have done what my vet did 20 years ago. You should have asked us, “Do you really want to put a 15 year old cat with widespread cancer through major surgery?”

 

Instead, the first time we heard you use the term “major surgery” – or even “surgery” at all – about the biopsy was after it was over when you were explaining the reason for some of Nicky’s vital signs. You said that the worrisome readings were not unexpected, especially for “an old guy” because Nicky had gone through “major surgery”.

 

When you said “major surgery” that first time, I suddenly felt like the Alec Guinness character at the end of Bridge on the River Kwai who says, “What have I done?” Phil and I were sickened by what we had initiated. We hadn’t thought of the biopsy as surgery. We thought that surgery was when the vet tries to remove the cancer, not when the vet takes samples to test to determine if there is cancer. We were naïve and uniformed, and you should have taken that possibility into account.

 

In one telephone conversation after the biopsy, you intimated that we should have been aware that this is major surgery. You said that in the case of humans, the person would need months to recuperate. We’re probably as informed as any layperson. Before we retired, I was a government attorney, and my husband was a teacher and the son of the physician who wrote the medical school textbook on liver disease. Yesterday, I told a friend this story, and she had the same reaction   . . . a biopsy is not a big deal; it’s just taking samples of tissues. She’s a college instructor. But we’re all lay people – not medically sophisticated. We don’t know things that are obvious to you.

 

We did ask you before the biopsy what the risks were, and you said that there was a 1% chance of a bad outcome. You added that that was bad for the 1%, but obviously otherwise not a high risk. That was the perfect opportunity for you to say, “Well, he is an old cat . . .”

 

In any event, the issue really wasn’t what the risks were because if Phil and I had been thinking clearly and if we had been properly counseled, we wouldn’t have put Nicky through this procedure even if there were 0% risk. It was an inappropriate procedure for a 15 year old cat with widespread cancer given our goal of doing what was in Nicky’s best interest. As it turned out, our plan for quality final days for Nicky became a nightmare of his spending his final days in your hospital with his abdomen sliced open and stapled shut, drugged out on pain meds, and going downhill following surgery that should never have been performed.

 

So, despite what you kept asserting, even if Nicky had recovered from this surgery and got chemo without side effects and lived longer in a comfortable condition, our view would not change: this biopsy should not have been performed. Surgery was not in Nicky’s best interest. We should have known that beforehand. It’s our fault for not thinking through what a biopsy must be, and not asking the right questions. But it’s also your fault for not asking us “Do you really want this for a 15 year old cat with extensive cancer?” Is medical care for animals so much an assembly line that surgeons just cut and don’t ask the most important question: what is best for this animal?

 

Nicky trusted us. We’re enclosing a photo of him taken on April 30, after he was on prednisone.  We see in his expression in this photo, as we saw in person, that he trusted us completely to do what was right for him. Instead, we condemned him to a torture chamber. Nicky suffered terribly, and Phil and I continue to be devastated by what we did to this sweet kitty who put his trust in us.

 

We hope that this time we’ve been successful in communicating what we tried to explain to you last week in person and on the phone. But most of all, we hope this experience makes a difference in how, in the future, you advise/question people who have elderly animal companions with cancer.

 

Sincerely yours,